• Chest · May 2014

    Multicenter Study

    Short- and medium-term prognosis in patients hospitalized for COPD exacerbation: The CODEX index.

    • Pedro Almagro, Joan B Soriano, Francisco J Cabrera, Ramon Boixeda, M Belen Alonso-Ortiz, Bienvenido Barreiro, Jesus Diez-Manglano, Cristina Murio, Josep L Heredia, and Working Group on COPD, SpanishSociety of Internal Medicine*.
    • Internal Medicine Service, Hospital Universitario Mutua De Terrassa, Universidad de Barcelona, Barcelona. Electronic address: 19908pam@comb.cat.
    • Chest. 2014 May 1; 145 (5): 972-980.

    BackgroundNo valid tools exist for evaluating the prognosis in the short and medium term after hospital discharge of patients with COPD. Our hypothesis was that a new index based on the CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations) index can accurately predict mortality, hospital readmission, and their combination for the period from 3 months to 1 year after discharge in patients hospitalized for COPD.MethodsA multicenter study of patients hospitalized for COPD exacerbations was used to develop the CODEX index, and a different patient cohort was used for validation. Comorbidity was measured using the age-adjusted Charlson index, whereas dyspnea, obstruction, and severe exacerbations were calculated according to BODEX (BMI, airfl ow obstruction, dyspnea, and previous severe exacerbations) thresholds. Information about mortality and readmissions for COPD or other causes was collected at 3 and 12 months after hospital discharge.ResultsTwo sets of 606 and 377 patients were included in the development and validation cohorts, respectively. The CODEX index was associated with mortality at 3 months ( P < .0001; hazard ratio [HR], 1.5; 95% CI, 1.2-1.8) and 1 year ( P < .0001; HR, 1.3; 95% CI, 1.2-1.5 ), hospital readmissions in the same periods, and their combination (all P < .0001). All CODEX C statistics were superior to those of the BODEX, DOSE (dyspnea, airfl ow obstruction, smoking status, and exacerbation frequency), and updated ADO (age, dyspnea, and airfl ow obstruction) indexes.ConclusionsThe CODEX index was a useful predictor of survival and readmission at both 3 months and 1 year after hospital discharge for a COPD exacerbation, with a prognostic capacity superior to other previously published indexes.

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